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anxiety

The Art of Not Knowing

The Art of Not Knowing

Having goals, dreams and desires implies looking forward and planning ahead. However, focus on the future is often accompanied by worries about hypothetical situations. Indeed, the things we care about the most are often ambiguous and unknowable. Because humans are hard-wired to prefer certainty to uncertainty, we experience this ambiguity as highly uncomfortable, even distressing. Considering that the future is uncertain and that being faced with the unknown is uncomfortable, we tend to develop strategies to avoid or reduce uncertainty. These may work in the short term. When intolerance to uncertainty becomes the rule, however, striving to eliminate it altogether paradoxically contributes to increased anxiety and suffering, and ultimately impedes our ability to reach our goals (Dugas, Gosselin & Ladouceur, 2001).

According to Kelly Wilson and Troy Dufrene, authors of Things May Go Horribly Terribly Wrong (a perfect title for a book on uncertainty), the first step to changing the way we relate to the unknown is to become aware of the myriad strategies we engage in to neutralize ambiguity (Wilson & Dufrene, 2010).

The list below may be helpful to begin thinking about which intolerance to uncertainty tactics we engage in the most and to prompt reflection on what uncertainty means to us.

1. Observe: How do I relate to uncertainty?

Approach Strategies:

  • Worrying to “solve” uncertainty. Worries are often plans, predictions and preparations for hypothetical situations that are ultimately ambiguous and unknown. It may feel “productive” to worry, but when the topic of worry is out of one’s control, such as for future events, worrying about it becomes an “intolerance to uncertainty strategy” and only leads to more worry.

  • Reassurance seeking. Asking for reassurance and seeking advice are also common ways to dispel uncertainty and to attempt to “feel certain”. Ex: Asking a loved one if they love you multiple times a day, asking multiple sources about an upcoming decision, getting second and third opinions…

  • Searching online. Digital and social media technology provides the luxury of quick and easy access to unlimited answers to our innumerable everyday questions. Through immediate and constant access to information, technology use in many contexts can take the form of reassurance seeking and, ultimately, reduces spontaneous daily exposure to uncertainty. Recent research actually shows that intolerance to uncertainty is a rising phenomenon that correlates with the rise of digital technology such as smartphones. Ex: Googling health questions as they occur, searching through someone’s or one’s own social media, excessive online-researching before making a decision (Carleton et. al, 2019).

  • Double checking. Double-checking may also easily become triple-checking or more. Ex: Repetitive checking of one’s bank account and email, repetitive-checking that the door is locked, double-checking the route to get to a destination.

  • Perfectionism, not delegating and overprotecting. To reduce uncertainty and to gain a sense of control, some may try to do everything themselves, over-prepare and not delegate to others. This may also take the form of perfectionistic tendencies relating to the idea that if everything is perfect, the outcome will be predictable and positive. People may also apply these strategies in the context of their relationships with significant others by being overprotective and doing things for them.

Avoidance Strategies

  • Procrastinating, choosing not to choose and indecisiveness. Putting off beginning a task that has uncertain outcomes. Will I be able to succeed? Am I good enough? Having trouble making decisions that have unclear outcomes and that include uncertain elements. These strategies may serve to minimize one’s experience of the discomfort of not knowing (Rassin & Murris, 2005).

  • Avoiding new opportunities. Avoidance of the experience of uncertainty may take the form of avoiding new experiences altogether. Ex: turning down a promotion for fear of not being good enough, not going to a party with new friends, not travelling to unknown places.

  • Cognitive avoidance. Efforts to not think about uncertain topics until it is absolutely necessary.

Beliefs about uncertainty

  • It feels irresponsible or dangerous for there to be uncertainty in life.

  • Uncertainty means that something bad will happen.

  • Belief that you cannot tolerate not knowing how things will go (“I will not be able to manage”).

  • Feeling that it is preferable to be certain that an outcome will be bad, than to not know the outcome.

As mentioned, everyone uses some of these strategies some of the time. Intolerance to uncertainty becomes most problematic when reliance on these types of strategies interferes with what’s most important to us.

2. Observe and notice: What are the costs?

The second step is to become aware of how regular use of these strategies interferes with one’s goals, relationships and general wellbeing. We may ask ourselves the following questions:

  • Are worries about the future getting in the way of my enjoyment of the present moment?

  • How much time am I spending trying to “solve” uncertainty? What else could I be doing?

  • What meaningful experiences am I avoiding or putting off due to intolerance to uncertainty?

  • Does my intolerance to uncertainty affect my relationships with loved ones?

3. Observe, notice and feel: Sitting with it. The final step implies doing the opposite of efforts to move away from uncertainty. In fact, it involves leaning into it and requires the willingness to experience its discomfort. If the only thing that is certain in life is that life is fundamentally uncertain, then acceptance of uncertainty, in all its discomfort, is necessary. Allowing oneself to simply experience ambiguity is not to love it, but to learn that it is both uncomfortable and tolerable.

  • How to sit with uncertainty? When resisting the urge to engage in strategies to reduce uncertainty, take a moment to explore your internal experience. Identify what you are feeling. Observe the sensations in your body, notice the feeling of your breath. Notice your thoughts. Remember, no matter how intense your thoughts and emotions become, they are temporary and they will pass. It may be helpful to remind yourself of the following coping statements: “This too shall pass”, “I do not know and it is okay”, “It is uncomfortable and I can feel it”, “It is uncertain, I do not need to solve it”.

  • For more information on sitting with difficult emotions, see this blog post.

4. Be flexible. The objective of these steps is not to eliminate our response of discomfort towards uncertainty. It is alright and normal to worry and feel anxiety at times. Rather, the objective is to become aware of how consistent efforts to not feel discomfort get in the way of engaging in experiences that are unknowable and likely to also be highly meaningful such as connecting with others and moving towards goals (Wilson & Dufrene, 2010).

Building tolerance to uncertainty is like strengthening a muscle. The more you work it out, the stronger it becomes!


Rhea Marshall-Denton is a Ph.D. candidate in clinical psychology at the Université du Québec à Montréal, and a therapist at Connecte Montreal Psychology Group. The team at Connecte loves writing about ways to boost our mental health and bring psychology into our everyday lives. For more helpful tips, check out Connecte’s blogspodcast, follow @connectepsychology on Instagram, or like us on Facebook.


References

Carleton, R. N., Desgagné, G., Krakauer, R., & Hong, R. Y. (2019). Increasing intolerance of uncertainty over time: the potential influence of increasing connectivity. Cognitive behaviour therapy, 48(2), 121-136.

Dugas, M. J., Gosselin, P., & Ladouceur, R. (2001). Intolerance of uncertainty and worry: Investigating specificity in a nonclinical sample. Cognitive therapy and Research, 25(5), 551-558.

Rassin, E., & Muris, P. (2005). Indecisiveness and the interpretation of ambiguous situations. Personality and Individual Differences, 39(7), 1285-1291.

Wilson, K. G., & Dufrene, T. (2010). Things might go terribly, horribly wrong: A guide to life liberated from anxiety. Oakland, California: New Harbinger Publications, Inc.

The search for certainty

The search for certainty

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I am a planner. I love doing research, making lists and weighing the pros and cons. For me, there’s a real comfort in knowing what‘s coming up so I can be prepared. The thing is, it’s not always possible to know. By its nature, life is uncertain, and if we spend too much time looking for absolute certainty, we miss out on many amazing possibilities.

For some, the unknown is thrilling. They look at it as an exciting adventure, regardless of the outcome. For others, the unknown is extremely unpleasant, and they are very anxious about possible negative outcomes. This is known as intolerance of uncertainty (Wever et al, 2014). For these individuals, doubt or uncertainty are seen as terrible and unbearable, and they will do almost anything to avoid these feelings. Intolerance of uncertainty is associated with a number of disorders, including generalized anxiety disorder, obsessive compulsive disorder and depression (Carleton et al, 2012).

One way in which many clients feel that they can deal with uncertainty is by worrying. They often tell me that worrying helps them to prepare for the worst, and gives them a sense of control. Indeed, worrying may lead to a reduction in feeling uncertain, which then leads to even more worrying to continue to keep the feeling at bay.

Whenever I speak to a client about this, I always ask one question: does the worrying actually make things more predictable? Has your worry ever changed the outcome of a situation? While it may make you feel better for a short time, over the long term has it been successful or has it become a problem in and of itself? Okay fine - three questions :).

An important thing to work on is increasing tolerance for uncertainty. Remember, it is normal to have some fear of the unknown, but when this fear leads to excessive worry and avoidance, it may be time to practice challenging this fear. Here are a couple of things that can help.

A) Thought challenges

When you have the “What ifs” floating around, ask yourself the questions on this sheet and write the answers down. Writing them down is important because it allows you time to think and reflect on them, rather than dismissing them quickly.

B) Mindfulness

Mindfulness is a state of awareness focused on the present (read more about it here in Natsumi’s post). Because it is about the present moment, that means that we are not looking to the what ifs of the future. When you notice these what ifs, acknowledge them and make note of what is happening for you while they are present. Then, allow them to pass. Don’t engage with them, or try to get rid of them, just observe them and remind yourself that they are just thoughts (read more about thought defusion in Lisa’s post). Finally, know that they will come back. Not because you failed, just because that’s what thoughts do. When you notice them again, be proud of yourself for noticing, allow them to pass, and bring yourself back to the present.

The future is definitely unknown, and that can be tough. But why sacrifice experiencing what is actually happening now, worrying about something that may or may not happen?


Ava-Ann Allman is a clinical psychologist in Westmount, Montreal, Quebec, at Connecte Montreal Psychology Group. The team at Connecte loves writing about ways to boost our mental health and bring psychology into our everyday lives. For more helpful tips, check out Connecte’s blogspodcast, follow @connectepsychology on Instagram or @ConnecteMTL on Twitter, or like us on Facebook.


REFERENCES

Carleton, RN, Mulvogue, MK, Thibodeau, MA, McCabe, RE, Antony, MM & Asmundson, GJG. (2012). Increasingly certain about uncertainty: Intolerance of uncertainty across anxiety and depression. Journal of Anxiety Disorders, 26 (3), 468-479.

Wever, M. Smeets, P & Sternheim, L. (2014). Neural correlates of intolerance of uncertainty in clinical disorders. Journal of Neuropsychiatry and Clinical Neurosciences, 27 (4), 345-353.

Anxiety: A Few Tools for Your Toolbox

Anxiety: A Few Tools for Your Toolbox

I feel frustrated about anxiety. Why? Because I see people suffering from it a lot, and yet there are many things we can do to alleviate and manage our anxiety. Below I’ve described some basics on how to do so, using techniques from Cognitive Behaviour Therapy and Acceptance and Commitment Therapy.

What is anxiety?

Anxiety has been referred to as our fight or flight system; or, in more technical terms, our sympathetic nervous system. Anxiety is the physical and psychological symptoms based on a perceived threat. I like to think of it as an alarm system that tells us when there’s a threat. This system is there to keep us safe, but sometimes it is too sensitive and it goes off when it doesn’t need to. Like an overprotective grandma, it has good intentions but might stop of us from doing things that are relatively harmless.

People often find the physical symptoms that come along with anxiety uncomfortable or even distressing. At a physiological level, anxiety is a high state of arousal that results from a surge of adrenaline. It primes our body for action, primes our body to defend itself and increases our performance and stamina. Physical symptoms often include shaking, sweating, muscle tension, fast heartbeat and fast breathing. Overbreathing, or hyperventilation, which means breathing a volume of air greater than which we require, can result in additional physical symptoms, including chest discomfort, numbness or tingling in the hands and feet, dizziness, and faintness. 

 
 

Why do we have anxiety?

Given our experience of anxiety is probably mostly negative, it’s hard to remember why we might have anxiety in the first place. Anxiety is likely a protective mechanism that has evolved to prevent us from entering into potentially dangerous situations and enable us to escape from them. In fact, to a certain extent, anxiety can be good for performance. According to Yerkes-Dodson law, there’s an optimal ratio of anxiety and performance - We need some anxiety to perform our best, but too much anxiety can hinder our performance. A confident and experienced musician, for example, might perform her best in front of a live audience; whereas someone performing for the first time might have difficulty concentrating and focusing due to anxiety.

Our anxiety alarm system is sometimes too sensitive

It’s important to note that there are different levels of anxiety, and sometimes the level of threat doesn’t warrant the level of anxiety. Sometimes our anxiety alarm system is going off when it doesn’t need to. Overprotective grandma! For example, if we were hiking in the woods and came across an aggressive grizzly bear, our anxiety system might start going off in full force and we might be having thoughts like, “I’m going to die.” This is an appropriate thought – your odds aren’t great if you come across an aggressive grizzly bear. Alternatively, if you’re doing a presentation in front of classmates and you’re extremely anxious, you might also have thoughts like, “I’m going to die” and your anxiety alarm system is blaring. This is an example of when it's being overprotective. Of course it’s normal to have some anxiety when we’re doing a presentation - people are watching us and most of us fear being judged by others, but we’re not going to die.

Why does our anxiety alarm system go off when it doesn’t need to?

When our anxiety alarm system is going off when it doesn’t need to, it’s usually because we are excessively focusing on the worst-case scenario, or catastrophizing. That is, overestimating the probability of something bad happening and underestimating our ability to cope with a difficult situation, or assuming that people are noticing and judging us more than they actually are. This excessive focus on the negative will tell our anxiety alarm system that there’s a serious threat in our midst, and before we know it the alarm is going off.

Types of anxiety

As you probably already know, not everyone experiences anxiety in the same way or about the same situations. A helpful way to explore and understand the different types of anxiety is to break them down into thoughts, emotions, physical sensations, and behaviours. As you can see from the graph below, each part of the system influences the other, which also means we can intervene at any part to change the whole system.

Some common types of anxiety include anxiety for specific situations (e.g., anxiety when writing exams), generalized anxiety (excessive worrying about a range of things and difficulty controlling our worry), and social anxiety (anxiety that occurs in social situations when there’s a significant fear of being judged). Below I’ve described these different types of anxiety based on their associated thoughts, emotions, physical sensations, and behaviours. 

Know your thoughts

The first step in treating anxiety is to really understand the thoughts that are fueling your anxiety. This may sound easy, but our thoughts often happen automatically, outside our awareness, and we usually assume they are true without really noticing or considering them. In getting to know your thoughts, try to be your own detective and explore your thoughts with curiosity.

Here are some tips:

  • When you notice a negative emotion, ask yourself, what am I thinking right now? Take a few deep breaths.

  • Describe your thought (e.g., “I’m having a thought that I’m a failure.”).

  • Let go of judgment. Be kind and curious. When we judge ourselves for having certain thoughts, we add another layer of negative emotion. For example, we may think, “I’m so weak for thinking this way”, and then not only do we feel anxious, but we feel ashamed. Also, by adding this extra layer of negative emotion, we might not fully recognize what the initial thoughts and feelings were, and therefore we won’t be as effective in alleviating the initial anxiety (Linehan, 2014).

Challenge your thoughts

Once we've identified a negative or unhelpful thought, it's important to challenge it to see if it can be replaced with a more helpful, balanced thought. As I mentioned earlier, our anxiety is sometimes like an overprotective grandma. In other words, when we’re anxious, we may be excessively focusing on the worst-case scenario, or catastrophizing. Specifically, we’re likely overestimating the probability of something bad happening, underestimating our ability to cope with a difficult situation, or assuming that people are noticing and judging us more than they actually are. Challenging our thoughts allows us to replace these more extreme thoughts with a more balanced way of thinking, thereby decreasing negative feelings such as anxiety.

Here’s an example of an anxiety-inducing situation that most of us can probably relate to. Sam is talking to his friend Meg in the cafeteria. While they’re talking, Meg keeps looking over Sam’s shoulder at the clock on the wall. Sam thinks, “Meg thinks I’m boring” and begins feeling anxious and a bit sad. He is also experiencing tightness in his chest, and his stomach starts to hurt.

 
 

Here are some guidelines on how to challenge your thoughts, some questions you might ask yourself to come up with more balanced thoughts:

  • Thinking Traps: Am I falling into a thinking trap? Am I catastrophizing (thinking worst-case scenario)? Am I 100% sure that this will happen? Is this a small hassle or a life-altering problem?

  • Check the facts: What evidence do I have that this is true? What evidence do I have that this is maybe not true? Have I confused a thought with a fact? Is my judgment based on the way I feel instead of facts?

  • Alternative Explanations: Is there another way of thinking about this situation?

  • Role Reversal: What would I tell a friend if they had this thought? What would a friend tell me about this thought?

  • Ability to Cope: Could I cope with or handle the “bad” outcome?

  • Advantages and Disadvantages: Is it helpful to think this way? Even if it’s true, is it helpful to focus on this? Maybe it’s more helpful to try to find solutions for the issue, or to focus on the positive.

For more tips on challenging your thoughts and coming up with more balanced thoughts, refer to this handout on realistic thinking.

Consider alternative thoughts

Let’s say Sam tries to think of some alternative thoughts to his thought, “Meg thinks I’m boring.”

 
 
 
 

By considering these alternative thoughts, Sam will hopefully be able to make room for a more balanced and helpful way of thinking about the situation with Meg, and therefore feel less anxious.

Try thought defusion

There are times when it might be difficult to challenge the unhelpful thought that is fueling your anxiety. For example, maybe the thought is true, or it’s stubborn and sticks around even after you challenge it, or simply it feels true. A technique called thought defusion, from Acceptance and Commitment Therapy (Hayes, Strosahl, & Wilson, 1999), can help us with thoughts that we tend to get “hooked” on. With thought defusion, you will learn how to mindfully observe your thoughts without getting stuck on them. Also, with practice, it gives you the freedom to choose which thoughts you want to focus on and which thoughts you want to let go of.  Thought defusion requires imagining and visualizing your thoughts as objects outside of yourself going by, as pictures or words harmlessly floating away without you analyzing them or obsessing about them.

Here are some common thought defusion visualizations:

  • Imagine sitting in a field watching your thoughts float away on clouds.

  • Picture yourself on a mountain, looking down at a stream, and your thoughts as leaves on that stream floating by.

  • See your thoughts written in the sand and then watch the waves wash them away.

  • Envision yourself driving and watching your thoughts pass by on billboards.

  • Imagine yourself sitting under a tree, watching your thoughts float down on leaves.

Now try this exercise: Think about a time when you recently felt anxious (e.g., during an exam or presentation, during a conflict with a loved one, when meeting someone for the first time, while speaking up in a meeting at work, while riding in an airplane, etc.). Focus on that thought, and pick one of the visualizations above to help you get some distance from the thought.

Remember, the point of thought defusion is to get some psychological space from your thoughts, so you can see them a bit more objectively, less as truths, and then be able to choose with a clear mind whether or not you want to focus on them.  This short video explains the concept of thought defusion with some fun and simple illustrations:

 
 

Some tools for your toolbox…

It is important to note that these tools aren’t quick fixes, but with practice and perseverance, they can help you manage and alleviate your anxiety so that you’re not held back in your life by a well-intentioned but sometimes excessively protective anxiety alarm system. If you are experiencing a high level of anxiety, it is highly recommended you seek out professional help (check out our Resource Section). I have also listed some self-help resources below that many of my clients have found helpful.


Lisa Linardatos is a clinical psychologist in Westmount, Montreal, Quebec, at Connecte Montreal Psychology Group. The team at Connecte loves writing about ways to boost our mental health and bring psychology into our everyday lives. For more helpful tips, check out Connecte’s blogspodcast, follow @connectepsychology on Instagram or @ConnecteMTL on Twitter, or like us on Facebook.


References

  • Bourne, Edmund (2015). The Anxiety and Phobia Workbook: 6th Edition. New Harbinger Publications.

  • Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (1999). Acceptance and commitment therapy. New York: Guilford Press.

  • Linehan, M. M. (2014). DBT® skills training manual. Guilford Publications.

Resources

Book:

  • Bourne, Edmund (2015). The Anxiety and Phobia Workbook: 6th Edition. New Harbinger Publications.

Handouts:

Websites with handouts and materials:

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